There have been numerous advances in surgical techniques to repair orthopedic injuries. Arthroscopic surgery that at one time caused patients months of incapacitation and recuperation can now be accomplished with surgical procedures that are minimally invasive and foster fast patient recoveries. Most tears are repaired using arthroscopic techniques, categorized as either “outside-in” or “inside-out.” The inside-out technique requires that a surgeon place needles using arthroscopic visualization through both meniscal fragments and then out through the joint, exiting percutaneously. The needles pull sutures through the meniscal fragments and are used to stabilize a tear while it heals. The outside-in approach was developed to eliminate the large incision required in the inside-out method. In the outside-in procedure, a surgeon utilizes needles as in the inside-out technique. However, in this technique, safe passage of the needles is more easily controlled using knowledge of anatomical landmarks to avoid the peroneal nerve.
The outside-in procedure includes first directing a needle from a percutaneous arthroscopic accessory portal that is outside, and, then, directing the individual needles through the tissue on both sides of the meniscus tear. The surgeon is able to view inside via an arthroscope inserted through a viewing portal. Once the needles span the tear as seen through the arthroscope, a suture is positioned across the tear inside the knee using the two needles. After both needles exit the capsule, the needles are cut from the suture and an interference knot is tied on the suture and is formed from several knots tied onto a knot such that the resulting knot is large enough to prevent the interference knot from being pulled from the opening in the tissue made by the needle. When the needles are removed, the suture is left in place, and the interference knot is pulled back into the knee through the suturing portal until the knot is positioned against the tear site. The process is then repeated several times until the tear is stabilized. The procedure is completed by tying all of the suture tails together through an incision under the skin outside of the knee joint.
Both techniques focus on placement of sutures that bring two surfaces of the torn meniscus together so that healing may occur. Tying knots in sutures while operating in the extremely confined environment provided by the hollow needles is very difficult and requires incredible dexterity. Indeed, a substantial portion of the time required for the procedure is due to the time that it takes to place the sutures. While there exist numerous systems for facilitating the inside-out techniques and numerous systems for facilitating the outside-in technique, there exists a need for more efficient implementation techniques.